ABSTRACT
Lung function was recorded in a cohort of 130 age specific children of low birth weight (under 2000 g) and a reference population of 120 unselected local schoolchildren at 7 years of age. Children of the cohort were similar in height and forced vital capacity to the reference group, but had significantly reduced forced expiratory volume in 0.75 second and expiratory flow indices. Although neonatal respiratory illness was associated with reduced airway function, we were unable to confirm that this was a consequence of oxygen treatment or mechanical ventilation. Low birth weight, however, was closely associated with poor airway function independent of neonatal respiratory illness. Other factors of importance included the male gender and maternal smoking. The reduction in airway function observed in the low birthweight children was associated with cough but not wheeze. The disparity between the relatively well preserved vital capacity and reduced airway function suggests that very low birth weight, and hence prematurity, has its greatest effect on the subsequent growth of airway function. The absence of an association between neonatal oxygen score or mechanical ventilation and childhood lung function suggests that the long term effect of neonatal respiratory treatment is small compared with that of birth weight, maternal smoking, and male sex.
Subject(s)
Infant, Low Birth Weight/physiology , Lung/physiology , Birth Weight , Cough/etiology , Female , Humans , Infant, Newborn , Infant, Premature, Diseases/therapy , Male , Oxygen/adverse effects , Prospective Studies , Reference Values , Respiration, Artificial/adverse effectsABSTRACT
Twenty two boys with Duchenne muscular dystrophy were entered into a randomised double blind crossover trial to compare respiratory muscle training with a Triflow II inspirometer and 'placebo' training with a mini peak flow meter. Supine posture was associated with significantly impaired lung function, but respiratory muscle training showed no benefit.
Subject(s)
Breathing Exercises , Muscular Dystrophies/therapy , Respiratory Muscles/physiopathology , Adolescent , Child , Clinical Trials as Topic , Double-Blind Method , Humans , Male , Muscular Dystrophies/physiopathology , Random Allocation , Respiratory Function Tests , SupinationABSTRACT
Eighteen infants were entered into a randomized, placebo-controlled trial of dexamethasone therapy for chronic lung disease. Initial ventilation requirements were similar in the two groups, although all infants were in headbox oxygen on entry to the trial. The dexamethasone-treated infants showed a significantly more rapid improvement during the 1st week of treatment, although the overall duration of oxygen therapy was similar in both groups. Cranial ultrasound examination revealed new periventricular abnormalities in three out of the five dexamethasone-treated infants who had previously normal scans, compared with none of four similar placebo-treated infants. A large trial, focussing on potential complications, is now needed.
Subject(s)
Bronchopulmonary Dysplasia/drug therapy , Dexamethasone/adverse effects , Encephalomalacia/chemically induced , Leukomalacia, Periventricular/chemically induced , Administration, Oral , Clinical Trials as Topic , Dexamethasone/therapeutic use , Double-Blind Method , Humans , Infant , Infant, Newborn , Infusions, Intravenous , Oxygen/blood , Random AllocationABSTRACT
In a prospective study on a cohort of 7 year old children of low birth weight (under 2000 g at birth), we observed an increased prevalence of airway responsiveness to histamine compared with a reference population of unselected, local schoolchildren. The airway responsiveness to histamine was significantly related to a history of asthma in first degree relatives (natural parents and siblings) in both groups of children, but not to that of the mothers. There was no increase in the prevalence of maternal asthma, a family history of asthma, or airway responsiveness in the mothers of low birthweight children. We were unable to find evidence to support the hypothesis that maternal smooth muscle irritability (uterine and airway) has a causative role in the premature labour in the mothers and in subsequent bronchial hyper-responsiveness in their prematurely born children.
Subject(s)
Bronchi/drug effects , Histamine/pharmacology , Infant, Low Birth Weight/physiology , Respiratory Hypersensitivity/etiology , Asthma/genetics , Bronchial Provocation Tests , Female , Humans , Infant, Newborn , Obstetric Labor, Premature/complications , Pregnancy , Prospective Studies , Respiratory Hypersensitivity/complications , Respiratory Hypersensitivity/geneticsABSTRACT
Fluids used for flushing arterial catheters, bronchial lavage, and drug administration are not normally considered when assessing daily fluid intake, yet infants weighing less than 1000 g at birth gained up to 12 ml/kg/day of extra fluid and 2.4 mmol/kg/day (mean) of extra sodium from these hidden sources.
Subject(s)
Infant, Newborn, Diseases/metabolism , Sodium/administration & dosage , Water-Electrolyte Balance , Water , Critical Care , Humans , Infant, Newborn , Infusions, ParenteralABSTRACT
Effects of posture and spinal bracing on lung function were studied in 40 children with neuromuscular disease, 20 of whom had scoliosis and were non-ambulant. Change from sitting to supine position had little effect on lung function in ambulant children, but caused a significant 12% reduction in forced vital capacity in a group of 16 non-ambulant children with scoliosis, suggesting diaphragmatic weakness in some. Spinal bracing, using a rigid supporting jacket, resulted in a significant reduction in mean vital capacity of 22%. The degree of impairment in forced vital capacity was proportional to the severity of the scoliosis (as measured by the Cobb's angle), to the amount of correction achieved by the brace, and to the degree of diaphragmatic weakness. Spinal bracing in a child with established severe scoliosis causes appreciable respiratory impairment, and this may explain why it is less likely to be tolerated than early prophylactic bracing.
